Sometimes it can be hard for older adults to separate signs of mental health problems from aging-related changes. You may think that feeling sad or anxious is a normal part of getting older, especially when you live with challenging health conditions or lose loved ones.
Declining health and the challenges of managing multiple diseases can put seniors at risk for mental health conditions like depression or anxiety. If you’re struggling with thoughts of suicide or constant feelings of sadness or hopelessness, talk with a doctor about getting the help you need.
Medicare covers many benefits to care for your mental well-being, including psychological counseling, preventive screenings, and outpatient treatment programs
Here’s an overview of Medicare’s mental health coverage.
Does Medicare cover preventative Mental Health?
Preventive care can help identify patients who are at risk for mental health problems, so that they get necessary treatment sooner. Medicare Part B covers many preventive services, including screenings to access your risk for certain mental health conditions.
Medicare covers the following preventive benefits:
- Annual depression screening: All people with Medicare can get one free evaluation for depression per year as long as the doctor accepts Medicare assignment.
- Alcohol misuse screening: Some people with mental health problems may struggle with alcohol or drug abuse. Medicare covers one alcohol misuse screening per year. All Medicare enrollees who are not alcohol-dependent may qualify. If you’re alcohol-dependent, you may qualify for counseling (see below).
- ‘Welcome to Medicare’ visit: This introductory preventive visit includes a review of your risk for depression. You’ll need to have the exam within the first year of getting Medicare.
- ‘Wellness’ visit: During this annual visit, your doctor will evaluate your physical and mental health, and you’ll have the opportunity to bring up any mental health concerns with your physician. Your doctor may make recommendations based on your risk factors or refer you for additional treatment.
Does Medicare cover therapy, counseling, or psychologists?
Medicare Part B covers mental health services you get as an outpatient, such as through a clinic or therapist’s office.
Medicare covers counseling services, including diagnostic assessments including, but not necessarily limited to:
- Psychiatric evaluation and diagnostic tests
- Individual therapy
- Group therapy
- Family counseling (if the goal of therapy is to help your condition)
- Alcohol abuse counseling (up to four sessions)
Additional eligibility requirements may apply to qualify for these benefits. Keep in mind that Medicare doesn’t cover all types of therapy. You’re not covered for marital counseling or counseling with a pastor. You ’re only covered for mental health services you get through a licensed psychiatrist, clinical psychologist, or other health professional who accepts Medicare assignment.
Some people with mental health conditions may require more intensive treatment than a doctor or therapist can offer. Medicare also covers outpatient treatment programs, where beneficiaries can get more rigorous or structured mental health services without being admitted for inpatient care. These programs are known as partial hospitalization programs and are typically run through a hospital’s outpatient unit or a community mental health facility. You may be eligible for a partial hospitalization program if your doctor verifies that you’d otherwise need to be hospitalized as an inpatient.
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Does Medicare cover inpatient mental health care?
If your condition requires an inpatient stay, Medicare Part A covers general hospital and psychiatric hospital services. There’s a cap on Medicare coverage for inpatient services if you stay at a psychiatric hospital (versus a general hospital): Medicare Part A will only cover psychiatric hospital care for up to 190 days in your lifetime. Even when you’re admitted to a hospital as an inpatient, Medicare Part B covers doctor services you get during your hospital stay.
Does Medicare cover prescription drugs for mental health?
Stand-alone Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug plans can vary in both costs and which drugs are covered. To find out if a medication you need is covered by a specific Medicare plan that offers prescription drug coverage, check the plan’s drug formulary, which is a list of medications covered by the plan. The formulary may change at any time. You will receive notice from your plan when necessary.
Medicare Part D covers prescription drug benefits you may need for treatment of your condition. Original Medicare, Part A and Part B, doesn’t include drug coverage, although Medicare Part B covers some medications that can’t be self-administered, such as drugs given by injection. For other prescription coverage, however, beneficiaries with Original Medicare must enroll in a separate Medicare Part D prescription drug plan. Medicare Advantage enrollees can get drug coverage through a Medicare Advantage Prescription Drug plan, which includes Medicare Part A, Part B, and Part D benefits under a single plan.
Certain drugs that treat mental health conditions are in protected classes under Medicare Part D, including antipsychotic drugs, antidepressant drugs, and anticonvulsant drugs. With some exceptions, Medicare Part D prescription drug plans must cover most medications in these drug classes.
To find out if a Medicare Advantage or Medicare prescription drug plan covers your medications, look up the plan’s drug formulary (or drug list). If your plan doesn’t cover a medication you take, ask your doctor about switching to a similar drug that’s covered by the plan or file a formulary exception with your plan. Keep in mind that Medicare Part D prescription drug plans can vary in copayments and coinsurance costs, even if they cover the same medications.
This article is for informational purposes only. Nothing in it should be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.
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A person’s mental health refers to their state of psychological, emotional, and social well-being – and it’s important to take care of it at every stage of life, from childhood to late adulthood. Fortunately, Medicare beneficiaries struggling with mental health conditions may be covered for mental health services through Medicare. Mental health services are a system of care that aim to assess, diagnose, treat, and counsel – in an individual or group setting – anyone who needs help alleviating mental or emotional illness, symptoms, conditions, and disorders. Find out what is included in your Medicare coverage for mental health services and get the help you or a loved one need.
Does Medicare cover counseling services?
Counseling and therapy are mental health services covered by Medicare Part B (Medical Insurance). This includes visits with the following health care providers who accept assignment:
- Clinical psychologists
- Clinical social workers
- Clinical nurse specialists
- Nurse practitioners
- Physician assistants
Coverage: Medicare pays 80 percent of the Medicare-approved amount. You pay 20 percent of the Medicare-approved amount, the Part B deductible, and coinsurance costs.
Does Medicare cover psychologist visits?
Clinical psychologists diagnose and treat mental, emotional, and behavioral disorders – and are one of the health care providers covered by Medicare Part B.
Coverage: Medicare pays 80 percent of the Medicare-approved amount. You pay 20 percent of the Medicare-approved amount, the Part B deductible, and coinsurance costs. Check that your psychologist accepts assignment or is in your insurance providers network, otherwise Medicare will not pay for the services.
Does Medicare pay for psychotherapy?
Psychotherapy, sometimes called “talk therapy,” involves talking to a licensed and trained mental health care professional – typically a psychologist – to help the patient understand and identify problems contributing to his or her mental illness.
Coverage: Medicare Part B helps pay for individual and group psychotherapy with doctors or certain other licensed professionals allowed by the state where you get the services. Medicare pays 80 percent of the Medicare-approved amount. You pay 20 percent of the Medicare-approved amount, the Part B deductible, and coinsurance costs.
Does Medicare cover psychiatry?
Psychiatrists are trained medical doctors that can prescribe medications to treat complex and serious mental illness – and are one of the health care providers covered by Medicare Part B.
Coverage: Medicare Part B helps pay for a psychiatric evaluation. Medicare pays 80 percent of the Medicare-approved amount. You pay 20 percent of the approved amount, the Part B deductible, and coinsurance costs.
Does Medicare cover psychiatric hospitalization?
In severe cases of mental illness, a psychiatrist may determine a patient needs to be admitted to a psychiatric hospital or a general hospital for treatment – and Medicare Part A (Hospital Insurance) may help pay for inpatient mental health services during a hospital or mental health facility stay. During the hospital stay, Medicare Part B (Medical Insurance) may cover physician services provided.
Coverage: Medicare helps pay for mental health care in a psychiatric hospital up to 190 days. After this time, Medicare may pay for care in a general hospital. Out-of-pocket costs for a psychiatric hospital are the same as any other hospital for inpatient care that accepts Medicare assignment.
Does Medicare cover family counseling?
Medicare Part B may help pay for family counseling if the goal of the therapy is related to helping your treatment. In addition, grief and loss counseling may be covered by Medicare for qualified hospice patients and their families, if it is provided by a Medicare-approved hospice and available in that state. Medicare does not cover other types of relationship counseling, such as marriage counseling. You’re only covered for mental health services from a licensed psychiatrist, clinical psychologist, or other health care professional who accepts Medicare assignment.
Does Medicare cover therapy for depression?
Medicare Part B helps pay for one depression screening per year, and it must be done in a primary care doctor’s office or primary care clinic that can give follow-up treatment and referrals. In addition, Medicare beneficiaries are eligible to receive a one-time “Welcome to Medicare” preventive visit that includes a review of potential risk factors for depression.
Coverage: A yearly depression screening and preventive visit does not cost anything if your doctor or health care provider accepts assignment.
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